%0 Journal Article %@ 1399-0012 %A Rodríguez-Perálvarez, M %A De Luca, L %A Crespo, G %A Rubin, Á %A Marín, S %A Benlloch, S %A Colmenero, J %A Berenguer, M %A Navasa, M %A Tsochatzis, E %A De la Mata, M %D 2017 %F discovery:1556459 %J Clinical Transplantation %K Immunosuppression, T-cell mediated rejection, liver biopsy, liver transplantation %N 7 %T An objective definition for clinical suspicion of T-cell mediated rejection after liver transplantation %U https://discovery.ucl.ac.uk/id/eprint/1556459/ %V 31 %X A uniform definition of clinical suspicion of T-cell mediated rejection (TCMR) in liver transplantation (LT) is needed to homogenize clinical decisions, especially within randomized trials. The present multicentre study included a total of 470 primary LT recipients. The derivation cohort consisted of 142 patients who had clinically-driven liver biopsies at any time after LT. The external validation cohort included 328 patients who underwent protocol biopsies at day 7-10 after LT. The rates of moderate-severe histological TCMR were 33.8% in the derivation cohort and 43.6% in the validation cohort. Independent predictors (ie. risk factors) of moderate-severe TCMR in the derivation cohort were: serum bilirubin >4mg/dL (OR=5.83; p<0.001), rising bilirubin within the 4 days prior to liver biopsy (OR=4.57; p=0.003), and blood eosinophils count >0.1*109/L (OR=3.81; p=0.004). In the validation cohort, the number of risk factors was an independent predictor of moderate-severe TCMR (OR=1.74; p=0.001), after controlling for hepatitis C status. The number of risk factors paralleled the rates of moderate-severe TCMR in the derivation and validation cohorts (p<0.001 in both comparisons). In conclusion, increased serum bilirubin, rising bilirubin and eosinophilia are validated risk factors for moderate-severe histological TCMR, and could be used as objective criteria to select candidates for liver biopsy. %Z This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.